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HomeMy WebLinkAbout0060 INDIAN POND POINT - Health 60 Indian-Pond Point Mar.stons Pv1illt; A= 083 =-- .011 - 002 UPC 12943 i No,53LY osr.col15�' HASTINGS, NIN 00 606 O-r- J � V � � 0rno 1 r 1JII I 1 i -, TOWN OF BARNSTABLE LOCATION ,=no4;an -Pbno( J%;M SEWAGE# Z013- YJ `'ILLAGE /�, !�;I JS ASSESSOR'S MAP.&PARCE - INSTALLER'S NAME&PHONE NO. rxcaVoL4►on y7-)- OG53 SEPTIC TANK CAPACITY _ D -BOX PcDIQCL rn1 c- -%4 o N)L Y ! LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER ToScOk Browr% PERMIT DATE: /O• Z3 - 13 COMPLIANCE DATE: //- /S- )3 . Separation Distance Between the: ; =' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist ori:` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al-5 1 A3-��I B3- 2 F(a Jay' �� A 13 L3 O Commonwealth of Massachusetts _ F Title 5 Official Inspection Form - _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M y 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. Cityrrown - State Zip Code. - Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end.of the form. Important:When filling out forms A. General Information on the computer,use only the tab 1. Inspector key to move your cursor-do not Matthew Gilfoy. U � V use the return key. Name of Inspector B&B Excavation, Inc: �p Company Name 14 Teaberry Lane - Company Address Forestdale MA 02644 City/Town State Zip Code (508)477-0653 S113640 - Telephone Number License.Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR MOW). The system: ® Passes . ❑ Conditionally Passes ❑ .Fails El Needs Further Evaluation by the Local Approving Authority 11/6/13 Inspector's Si nature - .. Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the.system owner shall submit the. . report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does.not address how the system will perform in the future under the same or different conditions of use. I � 13 � t5ins•3/13 Title 5 Official Inspection Form:S bu�ce Sewage Disposal Syste Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface'Sewage Disposal System Form - Not for Voluntary Assessments 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ;M s 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ Title 5 Official Ins...pection Form Subsurface Sewage Disposal System Form 7 Not for Voluntary Assessments 60 Indian Pond Point. 4„M Property Address . Joseph Brown Owner Owner's Name information is Marstons Mills MA 02648 11/5/13 required for every page. City/Town State Zip Code Date ofinspection C. Checklist Check if.the following have been done. You must indicate"yes" or"no":as to each:of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ Z Were.any of the:system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of El ® this inspection? Were as built plans of the system:obtained and examined? (If they were not Z El available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? - ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with El ® information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil.Absorption System (SAS) on the site has. -- .. been determined based on: .... -. ® ❑ Existing information. For example, a plan at the Board:of Health. ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is:unacceptable) [310 CMR 15.302(5)] D. System Information Residential.Flow Conditions: Number of bedrooms (design):,, 6 Number of bedrooms (actual); 5 DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): 660 l5ins•3/13: :: Title 5 Official Inspection Form:Subsurface Sewage Disposal System:•.Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2011 = 334 gpd 2012 =419 gpd Sump pump? ❑ Yes ® No Last date of occupancy: March 2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 60 Indian Pond Point Property Address Joseph Brow-i Owner Owner's Name information is required for every Marstons Mill's MA 02648 11/5/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below):. General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1978 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 57"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: > 10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in working condition. No sign of leakage Septic Tank(locate on site plan): 4'4" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ® No Dimensions: 1500 Sludge depth: 3" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M s 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Wls MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): New d-box installed 11/5/13 Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (1)4'x6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching is dry and appears to be in working order. No signs of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately J Al,, ST T' [31= lgi& 't © y A2- G I O B 2: 2.2 ' A3 :: 6q ' M = ►�$ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: > 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/23/78 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 60 Indian Pond Point Property Address Joseph Brown Owner Owner's Name information is required for every Marstons Mills MA 02648 11/5/13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. q o 13 _q f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS la}»'J aft 01pplitation for 13i8 o8 Y *pstem Construction Permit �- r Application for a Permit to Construct( ) Repair ) pgrade( ) Abandon( ) ❑Complete System Xindividual Components Location Address or Lot No. ®(�end 10n 0 i n-r/eo Own is Name,Address,and Tel.No. Ass"e3 orr''s Map/Par^'cel l�f�5 l CG. �J0 f) Bry W(l 50 776— y,>3 tall�Nmee,Address,and Tel.No. Designer's Name,Address,and Tel.No. L)aj i,�)n Al/A Type of Building: Dwelling No.of Bedrooms �j Lot Size sq.ft. Garbage Grinder( ) Other Type of BuildingCJ r-nl No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date �— Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) New HID id—blo y Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board gWealth. j Signed Date 10 1 3 Application Approved by Date l0 — 3—� Application Disapproved by CJ Date for the following reasons Permit No. go I Date Issued to— f3 ri No. Fee / 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication f0Is oil Y steltt Construction Permit Application for a Permit to Construct( ) Repai ) pgrade( ) Abandon( ) ❑Complete System Individual Components Loca io Address Lot No. Ow is Name Address and Tel.No. o02r& - 0nL Dlnd10( o1nr 2/� ,�,jlSe h �U�vn .509. 77// f Assessor's Map/Parcel S (D— ya3 _jDstaller's Naame,Address,and Tel.No. Designer's Name,Address,and Tel.No. NA P Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder( ) ULOther Type of Building e S �nNo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 01 gpd Design flow provided M/Tgpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ,d Nature of Repairs or Alterations(Answer when applicable) H IU i Date,lasf inspected: Agreement: z The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board alth. Sig 344201A Date 1 I I�O 13 Application Approved by Date Application Disapproved by Date for the following reasons -13 Permit No. ad Date Issued to --------------- ,------------------------ --------------------------------------THE COMMONWEALTH OF MASSACHUSETTS ~ {{ BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI Y,thNwva� the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by �� ion at U nd i on _?o i<n+ T_DA O has been constructed in accordance with the p`rovision of Tit e 5 and the for Disposal System Construction Permit No.d2013 _1/I dated P Installer B1 ��,(t v ! wn Designer 84j #bedrooms Approved design flow !y gpd The issuance of this permit sh 1 not be trued as a guarantee that the system will function as designed. ' �� _� � o , ' c `�� r f Date Inspector j, ``, No. O -s t'� - - - - -Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS �18�109Ar �pstetn �Dn�trUCtion-�PrYItIt � '� Permission is hereby//g__raannted to Construct( Repair(- Upgrade( ) Abandon( ) System located at t�U `fnd t a n Vo i n 1 K D R O AA -JL1 I ( 1 S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction T st be� leted within three years of the date of this permit.�� Date C 3 Approved by e� i F Page ? of 1 Stanton, David �— From: Jack Nicoletti [jack@ridgerealty1.com] Sent: Wednesday, October 30, 2013 3:26 PM To: Stanton, David Subject: 60 Indian Pond Point, Marstons Mills, MA Hello Mr. Stanton„ This letter is to conf irm that the garbage disposal was removed at 60 Indian Pond Point, Marstons Mills, MA. As per our conversation this was done to show the septic is approved for a 6 bedroom and B&B Excavation has performed the inspection. Thank our or you f help.- Y Y p Jack Nicoletti Ridge Realty "When you're Ready, call TEAM Nicoletti" www.Ridgerealtyl.com 10/31/2013 00 J (� � ��^�J` rQ,s'`r`�-�, o �^�t-r `�'1► f�jdln,'f' / �e�Qr' 3 poop L G'C AT ION S AGE PERMIT NO. V11-- AGE INSTALLER'S NAME i ADDRESS i' e U I L D E R OR OWNER DATE PERMIT ISSUED ' r DAT E COMPLIANCE ^ .ISSUED >; r 1 - ` , + l S � _ \� y C-� �� �� 7 ''� - _ t �•� • �. ., ..` ,�H ��,Y� t No...B...-?gip._ ,.' Fxs..., f ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF 1-fEALTH ......................... . .............OF.......................... ;............ Applirativit for llispaaal Workii Tnntrurtion "truth ]j5 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal n System at: cation-Addres or No. fl 7 Own ......�/ ®„�.� Address a ............. Inst 1 Address QType of Building 3 Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) �+ per, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Other fi t res ••--••-•••-•-••-••.............•----... - W Design Flow...............................•••..gallons per person per day. Total daily flow......... 1.9.....................gallons. 1:4 Septic-Tank—Liquid capacity./00.0..gallons Length----9....... Width--'Y.......... Diameter................ Depth.....Y...... Disposal Trench—No..................... Width.........._._._.. Total Length----.--... ........ Total leaching area....................sq. ft. Seepage Pit No--------I----------- Diameter..&,. .......... Depth below inlet_..4............ Total leaching area..a43....sq. ft. Z Other Distribution box ( ) Dosing tank ( Percolation Test Results Performed by. 9 ................................. . .. Date...---- aTest Pit No. 1....�2_.__minutes per inch Depth of Test Pit-__-__-.).......• Depth to ground water_-___ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ io -. . .. . ODescription of Soil---�--�-��----------- - ------------ ----�----�-r-'-'`�_,'-.•--- -----._ ...._ ...-----•---------------•----•-----------------........_...... x �.`----- ��------ --- -----•-------•--- --- -----•.............. --- ...... W •-••-••--•-•----------------••----••............-••------------•- •••-•-••-••••••----•-••-•-••••-•------•------------•------------••--••---------•-••---•-•••-•---•-••--•••---•-••••--••••......••...... VNature of Repairs or Alterations—Answer when applicable------------- - _--__•----•---------.----.-----. ------------------------------------------------•------------•----------------------.....-•-•--•--•-------------------------------------------•------------------•-----------------------•--•••-••-•••-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI!Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.a-01 :... ............ ------- 9 _Datt Application Approved By... .=.A......,, ,/� �<,/. :.t.!��......•.. r% Date Application Disapproved for the following reasons:.................................................. .......................................................... •--------•-------------------•----•---------•---------------....-•---•-•--•-......-----.......---•-----...__.....-------•---------------------------------------------------------------................ Date PermitNo......................................................... Issued•....................................................... Date t , No.._.............�... ®,_ FE$...,. f ......... THE COMMONWEALTH OF MASSACHItSETT�S BOARD OF HEALTH ......................O F................................_........-----------.------------------------------------. Appliration for DispvM 10ork,5 Tontitrnrtion rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at: , •• cation-Addreo , yy��a� y� or(Loj No.y/1' Q y ............................................................ _..... _. ! r Own ^ Address;.,,, ................... -•-•--.-=�---- -----•-------- .7^ Inst 11 Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) I--I Other—T e of Building No. of persons............................ Showers — Cafeteria QQ' Other t es -----------•----•---------•••--••------••---•- ------------•-----------------------••-••.•--••-----•---•-- -.---•-- Design Flow......._._..... ....................gallons per person per day. Total daily flow......... !1 0.....................gallons. WSeptic Tank—Liquid capacity.1.00...gallons Length....0... .... Width.Y.......... Diameter................ Depth......41- __.. Disposal Trench—No..................... Width.................... Total Length...... ... Total leaching area....................sq. ft. Seepage Pit No........1........... Diameter..?-•C.1...... Depth below inlet..... :l-......... Total leaching area..aO....sq. ft. Z Other Distribution box ( ) Dosin tank ) �j Percolation Test Results Performed by.�#---_-_ .—-_ _______ Date... Test Pit No. I....!.2_...minutes per inch Depth of Test Pit.._.__1.1_......_ epth to ground water..... A-__. (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LY e - i� O Description of Soil I.� � � n •..� � W ------•---------------•---- ----------------------------------...............---------••-••------...-----------•------•-•-----------••--------•----•--•---------.....-----------•-•-----•--------.------ UNature of Repairs or Alterations—Answer when applicable........... ................................ -------------------•---------•----••-•---•--------------•----•-•--•••-••--•----•-----•-•-•--....-----•••--•...•----------------••--•-••--------•••-•---•-•---------•------•-••••----•-•..._.....-----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board . Signed..(?-.a ° . .... .........._A. ------------------- _.... Dat Application Approved By.... . �•-- .. l�,ro --•------- Date Application Disapproved for the following reasons------------------------•--------------------------------------•-----------------•-----•----•---•--•--•-------._ --•--•--------------•---...----------•----•-•-----------•-------------------------------------••--•....._........_....-•--•-----•-•------•-•---•-•••----------------------------------------•--•---.•---- Date r PermitNo........................................................ Issued....................................................... Date s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............I............................OF................................................................................... C9rdifiratr of font li nr�e THIS IS T CERTIFY, T the Indivi6ISewage Disp�s constructed or or Repaired ( ) by ` e'er 9 -`K ------....-•-- i ;......at.......•-•-�'•Z---- ----------- = 'r%t°.�' -- ...... t---� Z—------------------------------------ has been installed in accordance with the provisions of TITLE^5 of The State Sanitary Code as described in the �- application for Disposal Works Construction Permit No...... ........... dated__--------------------------------------_....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU A GUARANTEE THAT THE SYSTEM tWI FU CTION SATISFACTORY. DATE..... 1 ��.................................................... Inspector.... .---- -•--............................................................ THE COMMONWEALTH OF MASSACHUSETTS ai BOARD OF HEALTH ...................OF...-----......................................._..................._................- Nol.!.._' '.' /1� FEE..-x�'�-.: ........... Permission is. hereby granted...... ...' ".._.. '' r'•-- --•---•--------•--•-•---•-•--•••-----•--••-•...................•------•-•- to Construct-,(""') or gepair _ ) an Ind}vidualLSewage Disposal S-stem /,l✓° atNo. - t1 `� - .......... .. ................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated...............,.......................... $oard of Health DATE................ / ( .................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF .BARNSTABLE `f/'✓ o/tZ J� l UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS +� L v f ASSESSORS MAP NO 3 PARCEL NO. o ' ADDRESS.' Jam$ Incitayy Poocl 20�114 $2J VILLAGE: \rStohs Mt<1s NAME;_ CONTACT PERSON PHONE NUMBER -4 a g a 7(5 LOCATION OF TANK CAPACITY: TYPE OF FUEL. AGE: TYPE: LEAK {_ OR CHEMICAL* DETECTION 6oc, ��'t�ng �.�1 e�I SYSTEM! DATE: OF PURCHASE OF EACH: 1. (�sb 2. 3. 4. 5. DATE OF, FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS 7 f'em ova �- �o l "PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TAN ON THE BACK OF THIS CARD: lvl ~ �tn o� i� h ease 90V F.F.=Fc -rER= 9. + ' TYPICAL SYSTEM PROFILE r AREA PLAN FDN T P FINISH GRADE= NOT TO SCALE SCALE : I "= LIOI �5-'•�= FINISH GRADE OVER TANK= FINISH �+ GRADE OVER PIT--.4 LOT -3 D OFF RACE LANE o" - _ - _, _ PVC OR 2. G t. ACVZF- C. I. TEES 7 . 67 33 • . . • • • • I.pWER lVFT ,. °° .QD • • • • • • • e • • y 1� ? T ��. 73•So .: $O t3I " 15 GAL. 4" e •` • • • • • e • • • , r FLR�__ 7 4•QC? �r _ "0 G� f�! ��.i2.�ff�T I (D" I �'•�'�0t"N/ D �.,� .- REINFORCED DI ST BOX • � e • . • • • e CONCRETE • e • • • • 8 TO BE INSTALLED ON ' ' ' • • ' A LEVEL STABLE BASE • e • • • e e • e OlI UND�IZ • e • • • • • • • • e e ow 5J, t THE 54-AE3 , SEPTIC TANK q-' ` TO BE INSTALLED ON A • • • • • • e • • � LEVEL STAB BASE V !' i < 1` R 2u_1/8,_ 1/2 „WASHED PEASTONE ALL • ► • • • • . • • • e e I V' -. . BRIC IRB►.MORTAR COURSES AB GRADE IRONS, FINES . • • • • • . • • • f AROUND FREE OF IRO REQUIRED TO BRING COVER TO G 6 •O Qp " `'"---=- f +.�y' AND O DUST IN N PLACE t - - -- f LEACHING PIT ` l/jD1.4tj -�o w D / U 24 "C.i. MANHOLE COVER a 3/4 "TO 1-1/2"WASHED CRUSHED c, �N� �,Qal Q- FRAME - SEE DETAIL STONE ALL AROUND FREE OF BASE TO BE LEVEL f '3• �••w4, IRONS, FINES AND DUST IN 13, PLACE A>=r� oS_ ADE SEE SYSTEFOR FIN. M PROFILE i 7A ' y I �. .— r ,,, = SOIL AND PERCOLATION DATA cl �� ,l — e" PERC. RATE' < 'L MIN IN. rt l ` / / L 4 FOR INV.ELEV SEE ° INLET SYSTEM PROFILE TAKEN BY : C. D. SPOHR {` (22° LINE _ 0 6"•o nArz , syAu� i..�Ell oft Hsi F' ' (ctgc; , �s' / .►/ , Q - , ° o OPENINGS W/4 1/8" ° WITNESSED : ®,a t��-r�s�r f ` zo OUTER DIA. & I 3/4 E. 1� �. li' _ o a INSIDE DIA. , . TEST�PIT-GND ELEV. �0 TOTAL ° ; ;°, - TH #+ � - - AREA o 3 " LQ,4� S. 5. 0 Rl1 Lei U 7 0 {7' , ( ) .s.. 3 4-T 5.F, ° 2.4 �s _ ats D N STD= C' o 0 0 0 1, P I T o ° '` j_kGH—r -VIA f�R V4'fi�-T' 1 o a o o p o o ° `: : a L:A' Fc ( iROU D WATE9- M. 1� 0 .54 _ a ' � .a 4 6 6 DIA. AitiD BOT. ?�s-t HOLE r � � `•` + ttx7o rp , E ..`�1 ^.t IA Cc EFFECT1VE 01A. ' � � � t�r�s-t' •; _ a - DOWN. 12 ��- �o>vca�•w � '� � LEACHING PIT SECTION I P►�' 4�•t~_Q1:� El.>=�/, T 14-Q ` 8e pRaPt LE' NO SCALE DATA •. IP ' # � � DESIGN DA ( ��``"!!! NOTE: DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM _ DISPOSAL r N0. OF BEDROOMS LEACHING PIT NOTES: EST. TOTAL DAILY EFFLUENT GALS PRCCAAST couctz ``t EACH I Imcan- I RF'QD• s�V�TAAi1-45 An I . CONC. TO BE 4000 P.S.I a 28 DAYS . �' SEPTIC TANK G AL.�M IN I UM1) s Pc 61=1 LE R P f- N 2. REINF. W 6 x 6 6 GA. W. W. M. -3. 2 'AND 4 ' SECTIONS ARE AVAILABLE FOR ' AREA 'F�lz.12F-,S>�'FZYE PIT GN Y0 t,.AK l GENERAL NOTES lI GREATER DEPTH REQUIREMENTS t LEA / /' ` 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN Z.6,`�' AC NOTE: } ACCORDANCE WITH TITLE5 OF THE STATE SANITARY CODE c ! EXCAVATE TO ELEV. — OR LOWER AS y I DATED JULY 1,19T7 d ANY LOCAL RULES APPLICABLE. gREQUiRED TO REMOVE ALL LOAM AND CLAY CONTAINING 2• ANY CHANGE TO THIS PLAN MUST BE APPRD. IN MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL WRITING BY MR. CHARLES D. SPOHR. WITH CLEAN CLAY FREE GRAVEL MECHANICALLY w ' 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, at COMPACTED IN PLACE. NOTIFY THE ENGINEER AND BOARD OF HEALTH FOR INSPECTION. 1 SIDE AREA= ` I 'S l-S.F. S.F./GAL -455 GALS I toy _ I •p I ��r 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. BOTTOM AREA= S.F.@' S.F./GAL GALS \NTOTAL AREA = 347 S.F _ TOTAL 6-e GALS 5. THESE ELEVS. MAST NOT 8E CHA14GED WITHOUT WRITTEN APPROVAL BY CHARLES D. SPOHR. ` iiF 2E,QU1 sZti ? A LEGEND A5�t3 SY 5o%a -6. FOUNDATION INSPECTION READ. WHEN EXCAVATED. I + 50.0• EXIST. GROUND ELEV. `'Q9v1$tows �'Q- c tST.�ra�> sc, osw IAM' .>~trrt ARCH 1 ':T��T• �� n t• t� - tl 1' •I( M.4JQ2. b / 50.0 FINISH GROUND ELEV. UNDERLINED `i` _ JOHM. -E, E3ARI\JA�DJR • REV. DATE DESCRIPTION ,.'' ,. '' F8 J R PIPE INVERT. ELEV. „ (D TEST PIT LOCATION SEWAGE DI SPOSAL _ SYSTEM FOR c p ��1 , t o O SEPTIC TANK MR. JOSEPH S. .BROWN ❑ ; _ DISTRIBUTION BOX ^MAs�� LOT -# 3 D OFF RACE LANE T 4" C. I . PIPE O• _ czaa.-les D. MYSTIC LIKE, MARSTON M 1 LLS 4"BIT. FIBER PIPE —TIGHT JOINTS i . ( SPflR j \ / IN DESIGNED: C•D.SPOHR DATE:23 SAY 7R DRAWING N0. - -- - PROPERTY 'LINE f DRAWN: SCALE:ASSHOWN MIN. CODE DISTANCEy_-�/ MAP SEC I PCL I LOT IHOUSE I CHECKED: C. D. S . TEL